Health care ‘navigators’ rush to enroll residents before deadline

Since she started spreading the word about the new health care law, Cynthia Solesbee has encountered many questions — and opinionated remarks — about a sweeping change affecting tens of thousands of people without insurance across the far western part of the state.

It is perhaps one of the few certainties in her busy schedule as a kind of health care messenger in Macon County.

Without an office, she has conducted a flurry of presentations at libraries and health departments, along with arranging appointments, including on weekends, over the past couple months.

“I feel like I need to clone myself,” Solesbee said. Her reach extends from Franklin and Highlands to the rural community of Nantahala, where she is helping uninsured people to select insurance policies mandated under the new health law. “We’re really, really busy right now,” she said.

Solesbee is one of seven so-called “health care navigators” dispatched through the seven western counties to help people sort through the new health insurance exchange, figure out their options and enroll.

Federal grants are funding these health care navigators all over the country, usually through existing nonprofits and social agencies. Here, Mountain Projects, a nonprofit social service agency, got $360,000 in federal funding to hire a team of health care navigators for the region.

Legal Aid, a service that offers legal services to low-income people, is also providing health care navigator services in the region although on a much smaller scale than Mountain Projects, with only one part-time navigator compared to Mountain Projects’ eight.

The navigators are trained to guide the people the new health law will affect — most uninsured adults under age 65. They can help them shop for a new plan in the online federal insurance marketplace, or determine whether they qualify for subsidies based on their household income and family size. For those without Internet access, paper applications for enrollment are available.

The grant money is expected to run out next August. After that, it’s uncertain how much help will be available to those trying to find insurance in the far western region.

In the short term, though, the navigators have been rushing to encourage people to enroll, in order to get their health plan processed by the first of the year.

Beating the deadline

“I’m just trying to get as many people enrolled as possible,” said Jan Plummer, a navigator with Mountain Projects who has spread word about the new law around Haywood — from fire departments to a Maggie Valley pancake house — since she earned her certification in September.

Those who fail to sign up for a health plan before March 31, 2014, will draw a federal fine. The Internal Revenue Service has said it will withhold the fine from tax refunds, unless the unenrolled are facing major changes in their circumstances, including marital or job status. Some individuals and married couples can apply for exemptions based on other factors, such as bankruptcy or a claim that the law — which subsidizes birth control — violates their religious liberties.

The law exempts businesses with fewer than 50 employees from offering coverage to employees.

These efforts by people like Solesbee and Plummer are crucial in North Carolina.

The state refused earlier this year to expand Medicaid, the federal program that gives health coverage to low-income people. The new law offered to pay states to include more people in the program. North Carolina’s refusal to accept the expansion left at least 500,000 people unable to apply for health benefits they would have qualified for, according to the N.C. Division of Medical Assistance.

Medicaid currently covers about 1.8 million people in North Carolina, including those under age 18, people with disabilities, some pregnant women, low-income parents and elderly.

Nearly 9,000 people across North Carolina have enrolled in a health care plan through the exchange as of last week, according to federal officials, though they make up only a tiny fraction of the one million expected to shop for one under the new federal law.

It is unclear how many of them live in the seven counties in the far western part of the state.

Here, the percentage of uninsured — nearly one-fourth of the population, or 30,000 people, according to 2012 data by the Census Bureau — is slightly higher than in other parts of the state, said Jane Harrison, a navigator covering Haywood and Jackson counties for Mountain Projects. About 20 percent of the population in North Carolina, or more than 1.5 million, were uninsured in 2012.

Navigators in this region have to go to great lengths to spread awareness about the new law, particularly due to the mountainous terrain and limited Internet access. More than 2,200 people have been helped since October, whether through public presentations or personal appointments.

But the thought of such a law, under which younger generations and middle- and higher-income earners generally will pay more to help subsidize insurance for those with lower incomes, remains alarming to many in more conservative parts of the state.

And the rocky start added to that wariness, including initial glitches with the website and the fact that some people with existing policies lost coverage despite assurances by the president that the federal mandate would not affect them.

Some have expressed their displeasure to Mountain Projects. Employees have received several unpleasant phone calls and messages in recent months, said Patsy Dowling, the director of the organization, which has offices in Waynesville and Sylva.

She believes such critics might view the group’s push to enroll people under the new health law as a kind of political stance, but Dowling said the group does this only out of a sense of responsibility.

“It’s a law that we have to comply with,” she said, adding that the number of such calls has since decreased.

Whatever the attitudes, counselors have recalibrated their approach in recent weeks, making it a point to dismiss misconceptions about the new health law “so that people aren’t afraid of it,” Plummer said.

Many remain unaware, the navigators say, that they might qualify for subsidies.

Others have considered not paying for insurance until they encounter health problems. But counselors point out that enrolling in a new plan would offer preventive care and that premiums are not affected by preexisting conditions. Why delay coverage?

At a presentation at the Macon County Public Library on a recent weekend morning, Solesbee, the navigator there who is a former tax professional, used the moment to try to offer a sense of assurance to the small group that turned out.

A handful of people, no more than 10, riffled through the table of brochures and handouts and dutifully listened to Solesbee’s presentation.

With several of these public sessions under her belt by now, Sollosbee had perfected the art of boiling down health care reform. She started with a 10-minute animated video, laced with ocassional humor, about what the affordable health care law means in layman’s terms.

Then she began running through a list of the most frequently asked questions the navigators get.

The small audience didn’t seem particularly enthusiastic.

The only comments from the audience were from a lady who clearly had a bone to pick. She posed antagonistic questions to the presenter and other audience members, frequently interrupting and blurting out negative comments.

Two people in the audience were there to gather information for their uninsured adult children.

An uninsured middle-aged couple was also in the crowd, but declined to share their name.

“It’s a complex law,” Solesbee told them. “And we have answers.”

Isolation: the biggest challenge

That is the message Julia Buckner has sought to spread in Graham and Swain counties, across whose gorges and towns she has rushed to give presentations and keep appointments since earning her certification as a Mountain Projects navigator a couple of months ago.

The two counties are among the poorest in the state, with Graham having the third-highest unemployment rate, according to the N.C. Employment Security Commission. “When you’re here in the middle of nowhere,” said Buckner, access to the Internet is limited.

And although the new law likely will bring lower premiums to the region’s working poor, she has encountered anxiety over the cost.

So she replies with numbers, saying that of the some 40 people she has helped enroll so far, a handful have qualified for health plans costing less than $2 per month.

The following question, usually, is uttered with a note of relief: “Is that price for real?”

Get help:

For specific questions, or to schedule an appointment to enroll, contact the closest enrollment counselor.

• Swain, Julia Buckner 828.550.7908 This email address is being protected from spambots. You need JavaScript enabled to view it.

• Haywood, Jan Plummer 828.400.3222 This email address is being protected from spambots. You need JavaScript enabled to view it.

• Haywood, Vicky Gribble 828.400.8678 This email address is being protected from spambots. You need JavaScript enabled to view it.

• Jackson, Rebecca Mathis 828.400.7012 This email address is being protected from spambots. You need JavaScript enabled to view it.

• Macon, Cynthia Solesbee 828.400.4177 This email address is being protected from spambots. You need JavaScript enabled to view it.

The Naturalist's Corner

This year will mark the 117th annual Audubon Christmas Bird Count (CBC.) The CBC is the longest-lived and largest citizen-science project in the world.

The count began in 1900. It was the brainchild of Frank Chapman, one of the officers of the fledgling Audubon Society. Chapman created the “bird census” as an alternative to the traditional Christmas “side-hunt,” a contest where groups would shoulder their arms and hit the fields and/or woods — the team that came back with the greatest number of corpses would be declared the winner.